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Understanding the Impact of Stimulants on Sleep in ADHD: Evidence from Systematic Assessment of Sleep in Adults

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Stimulants are widely prescribed to manage attention-deficit/hyperactivity disorder (ADHD) in adults. Stimulants promote wakefulness and can produce insomnia side effects. We hypothesized that systematic studies of sleep effects would reveal patterns of sleep impairment that may be important for clinicians to monitor and manage. We conducted a review and analysis of studies that measured sleep systematically during stimulant treatment in adults. We identified nine studies that met our search criteria, including four double-blind placebo-controlled studies. All studies recorded self-report subjective sleep quality data, three studies collected actigraphy data, and three studies collected polysomnography data. One study found better subjective sleep quality under open-label treatment conditions. Both polysomnography studies found improvement in aspects of sleep patterns. Two of the actigraphy studies suggested that adults receiving stimulant treatment may have less movement during sleep, and one showed reduction in amount of sleep. Further research could inform best practices for maintaining sleep quality during stimulant treatment.

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Correspondence to Craig B. H. Surman.

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Conflicts of Interest

Dr. Craig Surman, MD, has received, in his lifetime, consulting fees from Eisai, McNeil, NLS Pharma, Nutricia, Pfizer, Adlon/Purdue, Rhodes, Shire, Somaxon, Sunovion, Supernus, Takeda, and Teva; payments for lectures from Alcobra, Arbor, McNeil, Janssen, Janssen-Ortho, Novartis, Shire, Reed/MGH Academy (funded by multiple companies), and GME CME (funded by multiple companies); royalties from Berkeley/Penguin for “FASTMINDS” How to Thrive if You have ADHD (or Think you Might)” and from Humana/Springer for ADHD in Adults: A Practical Guide to Evaluation and Management. Dr. Surman has also conducted clinical research at Massachusetts General Hospital supported by Abbot, Cephalon, Hilda and Preston Davis Foundation, Eli Lilly, Magceutics/Neurocentria, Jazz, Johnson & Johnson/McNeil, Lundbeck, Merck, Nordic Naturals, Shire, and Takeda. Daniel Walsh has no conflicts of interest that are directly relevant to the content of this article.

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Author contributions

CBHS: Direction of literature search and analysis of results, outline and draft of entire manuscript, editing and final revision of manuscript. DMW: Conduct of literature search, draft of methods and results sections, editing of manuscript.

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Surman, C.B.H., Walsh, D.M. Understanding the Impact of Stimulants on Sleep in ADHD: Evidence from Systematic Assessment of Sleep in Adults. CNS Drugs 36, 253–260 (2022).

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